A nurse is preparing to feed a newly admitted client who has dysphagia.

Which of the following actions should the nurse plan to take?

Talk with the client during her feeding.

Discourage the client from coughing during feedings

I nstruct the client to lift her chin when swallowing

Sit at or below the client’s eye level during feedings

Answer and Explanation

The Correct Answer is D

The correct answer is choice D. Sit at or below the client’s eye level during feedings.

This action helps the client feel more comfortable and less intimidated by the nurse. It also allows the nurse to observe the client’s swallowing and signs of aspiration more easily.

Choice A is wrong because talking with the client during her feeding can distract her from swallowing properly and increase the risk of aspiration.

The nurse should encourage the client to focus on eating and avoid conversation until the feeding is over.

Choice B is wrong because discouraging the client from coughing during feedings can prevent her from clearing her airway and expelling any food particles that might have entered the trachea.

The nurse should monitor the client for coughing, choking, or changes in voice quality, which are indicators of aspiration.

Choice C is wrong because instructing the client to lift her chin when swallowing can actually make swallowing more difficult and increase the risk of aspiration.

The nurse should instruct the client to tuck her chin when swallowing, which helps close off the trachea and direct food into the esophagus.

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Correct Answer is D

Explanation

The correct first action for the charge nurse to take in response to an increase in facility-acquired catheter infections is toidentify possible precipitating factors related to the infections. This is because understanding the root cause of the problem is crucial before implementing any changes or interventions. By identifying the factors contributing to the increase in infections, the nurse can then develop targeted strategies to address these specific issues.

Now, let’s discuss why the other options are not the first actions to take:

Schedule nursing staff training for infection control procedures: While training is important, it should be based on identified needs. Without first understanding the precipitating factors of the increased infections, the training may not address the actual issues at hand.
Meet with providers to discuss measures to decrease the infections: This could be a subsequent step after identifying the precipitating factors. Meeting with providers without concrete data or understanding of the problem may lead to ineffective solutions.
Revise the current policy for catheter care: Policy revision should be based on evidence and identified needs. It would be premature to revise policies without first understanding what factors are contributing to the increase in infections.

In summary, the first step in addressing a problem is always to understand its causes. Only then can effective solutions be developed and implemented.

A. Allow the client to choose among a variety of activities each day. B. Give the client one simple direction at a time. C. Reinforce orientation to time, place, and person. D. Establish eye contact when communicating with the client. E. Refute the client’s delusions using logic.

Correct Answer is ["B","C","D"]

Explanation

The correct answer is choice B, C, and D. The nurse should give the client one simple direction at a time, reinforce orientation to time, place, and person, and establish eye contact when communicating with the client.

These interventions can help the client with dementia to understand and follow instructions, reduce confusion and anxiety, and enhance communication.

Choice A is wrong because allowing the client to choose among a variety of activities each day can overwhelm and frustrate the client with dementia.

The nurse should provide a structured and consistent daily routine for the client.

Choice E is wrong because refuting the client’s delusions using logic can increase the client’s agitation and distrust.

The nurse should use validation therapy to acknowledge the client’s feelings and emotions without arguing or correcting the client.

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A nurse is preparing to feed a newly admitted client who has dysphagia. Which of the following actions should the nurse plan to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A charge nurse is concerned about a recent increase in facility-acquired catheter infections. Which of the following actions should the nurse take first?

Correct Answer is D

Explanation

A nurse is planning care for an older adult client who has dementia. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.).

Correct Answer is ["B","C","D"]

Explanation

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A nurse is preparing to feed a newly admitted client who has dysphagia.

Which of the following actions should the nurse plan to take?